Mendosa Interview with Dr. Bethea

Interview with Morrison C. Bethea,
M.D.

This interview with Morrison C. Bethea, M.D., one
of the authors of Sugar Busters!, was conducted by telephone on
May 20, 1998, with Rick Mendosa, a freelance writer specializing in diabetes
who was writing an article about Sugar Busters! for Diabetes
Interview magazine. That article was published in the September 1998
issue.

MB: If one steps back and looks at the concepts behind
Sugar Busters!, if we break it down to the medical basis, to the biochemical
and physiological basis, if we get one to eat in the fashion as you go
through the day with lower insulin levels and hopefully higher glucagon
levels, so that you tend to burn more fat and store less fat. Now, if
you could have pecan pie and Häagen-Dazs ice cream and achieve those
goals, we would recommend it. But I here to tell you that you cannot.

And so we think that we have identified or brought
to light a very important concept. We havent come up with any new
science or any new physiology or biochemistry. Its all there. I
think that if one looks at the nutritional forest, to use that as an analogy,
it has four trees in it. There is the carbohydrate tree, there is a protein
tree, there is a fat tree, and there is a fiber tree.

We have been so consumed with fat that we are not
seeing the forest because of that one tree. And as you know, Americans
have been doing a pretty good job in reducing fat intake. Since 1970 overall
fat consumption has dropped about 16 percent. But unfortunately obesity
has gone up significantly over the last 20 years in the United States
and so has diabetes, so we are missing something. And the only thing that
we are saying in Sugar Busters! is look, we applaud what many of you have
done to reduce your fat intake, especially saturated fat and you need
to continue doing that. But wait a minute. Thats not enough. We
need to look at sugar, because the average American is consuming an excessive
amount of refined sugar and processed grain products and they may not
even know in many instances or are deleterious to them and they are not
aware of this.

RM: And sugar goes by so many names too.

MB: Right. We have reduced fat and cholesterol in
food products and have often substituted refined sugar products, like
Snackwell or like many of the quote sports drinks and so forth that are
full of refined sugar. So we doing ourselves a disservice by consuming
the amount of sugar in the processed or refined form that we are consuming.
So the only thing that we are saying is that we are not a no-sugar diet.
We may not be a low-sugar diet. We will be a low-sugar diet for a lot
of people because we want them to address that unnecessary excessive amount
of refined sugar they eat. More importantly, we are a commitment to making
correct carbohydrate choices. We want you to take your sugar in forms
that are whole grain or high-fiber carbohydrates, because that fiber is
going to modulate or slow down digestion, absorption, and elevate the
blood sugar concomitantly with the elevation of insulin levels and then
we achieve what we are trying to do, which is to get you to go through
the day with lower insulin levels.

We also want you not to go to an extreme with fat,
so that you dont eat any meat, because then you lose the source
of glucogon, which helps you burn fat. So we are saying, yeah, we want
you to be careful about food, but not to the exclusion of lean and trim
meats, which are good sources of protein. Basically, thats it. Its
not anything really revolutionary. Its not anything that we have
invented or come up with. Its not any science. If you could go back
to Arthur C. Guytons textbook of Medical Physiology -- thats
been the standard textbook of medical physiology in all medical schools
and training programs for many decades -- if you read the section on carbohydrate
metabolism, if you read on metabolic rates of temperature that deal with
all the metabolism that deal with the breakdown of carbohydrates, then
you see very quickly that most of the fat on our body does not come from
fat. It comes from sugar. Its all there. Its been there. We
read it in medical school. Lot of times we forget it by the time we get
out in practice. What weve tried to do is go back and pull this
data up and say we need to realize what we are eating and what happens
to it after we are eating it, make adjustments so that together with being
careful about fat we do some other things that help our weight, help us
if we happen to have a disease like diabetes, help us maybe not become
pre-diabetic, help us with our lipid chemistry.

RM: You are a cardiothoracic surgeon?

MB: That is correct. Heart and blood vessel surgeon.

RM: Since you are the heart specialist on this team
-- its neat that you have such a team of authors -- comment please
on fat. I know you dont talk about counting calories or weighing
or measuring, but do you have any general guidance on saturated fat and
other types?

MB: If you look at the proportion or what would make
up percentagewise you should eat over a 24-hour period, probably less
than 30 percent should be fat.

RM: 30 percent of calories from fat?

MB: Not calories. I am going to address calories in
a minute. Of what you eat. 30 percent or less of the mass of what you
eat should be fat. I say a little less than 30 percent. Of that, 10 percent
or less should be saturated. About 30 percent protein and about 40 or
a little higher carbohydrates.

RM: So this is certainly not a non-carbohydrate diet.
Not like Atkins.

MB: Absolutely. You get ketoacidotic. Your kidneys,
heart, muscles do not function properly in an acidotic state. You can
lose weight. But its not sustainable and consistent with good health.
Like a diabetic. [A few words missed.] Thats the problem. You dont
have insulin to get the sugar in the cells. The cells go to anaerobic
glycolysis and you come up with ketone bodies. You get acidotic. You dont
do well. So youve got to have carbohydrates.

What we are saying is, wait a minute. Lets look
at the form of that carbohydrates. Lets eat less insulin-producing
carbohydrates.

Now, you mentioned calories. Calories is a term that
came about in the 1840s. A calorie is a unit of heat necessary to raise
the temperature of one kilogram of water one degree centigrade. To be
quite specific, between 15 and 50 degrees. It doesnt have any weight
to it. It is just a characteristic. We think that you would be better
served, certainly with carbohydrates in looking at the glycemic index.
Picking those foods that are certainly moderate or low-glycemic carbohydrates.
Not picking those carbohydrates that are high glycemic, i.e. digested
quickly, absorbed quickly, raises the blood sugar quickly, and subsequently
the insulin levels. So the glycemic index of a carbohydrate is a better
characteristic of that food to look at than the calories. The calories
are pretty consistent. There are 4 calories per gram of carbohydrates,
9 for fat, and 4 for protein, and 7 for alcohol.

We mention that it is not necessary to weigh, count,
or measure, because people are not going to be compliant with that. If
you go into a restaurant and weigh, count, or measure, they will get ready
to give you a heave. So people are not going to do that. And Ive
looked as some of these diabetic exchange programs, and I cant figure
them out sometimes! The general public is not going to do it. So, what
we try to do is to make this lifestyle, a dietary nutritional lifestyle,
its more than a diet, its a lifestyle because it is going
to alter peoples nutritional habits, so it involves exercise, and
we think thats important.

RM: Now, one of you doesnt exercise. Who is
that?

MB: Thats Leighton Steward.

What we do want you to do is to look at portion size.
We are giving you a nice way to figure this out. Do you know what a dinner
plate looks like? Its got a flat bottom and flared sides. Your meat
and two or three vegetables ought to fit neatly on the bottom of the plate.
It shouldnt be stacked. It shouldnt be up on the sides. It
shouldnt fall off the side. And when you fill it up correctly one
time, you shouldnt go back and fill it up again. Thats self-explanatory!
You know, and every person out there, whether theyve got a seventh
grade education or a Ph.D. or an M.D. degree or a law degree or whatever,
they know what a plate proportionately filled up ought to look like. But
I was a chemistry major in college and I defy myself to try to figure
out how many grams of this or that or how many calories, because foods
are combinations of different things. And you cant do it. So instead
of having dietary guidelines or recommendations that people cant
follow, lets put something out there that they can follow.

And one thing that is really distressing in regard
to diabetics, and I know a lot of diabetics who have gone to their doctor,
theyre gaining weight, their blood sugar is out of control, and
the doctor says, "Gee, youre not following your diet."
Well, you and I both know that many diabetics, if not most, are very conscientious
and try to do the right thing. The problem is that they get the wrong
advice. They have been told to eat a lot of pasta and a lot of baked potatoes
and a lot of stuff like that, which at the end of the day is converted
to fat, because we dont store sugar in any appreciable amount. Then
they go back to the doctor. The doctor says you are gaining weight. You
need to quit eating as much fat, you need to eat only starches. They do
that and they go back and theyve gained more weight. Its not
the diabetics fault, because the ones who require insulin or insulin resistant
as far as getting sugar in a cell, but they are not insulin resistant
when it comes to other actions of insulin such as progressively converting
all unused sugar to fat, such as blocking the mobilization and burning
of fat [illegible] and such as the production of cholesterol by the liver.
All these things insulin potentiates or facilitates and thats the
downside to continuing to give them insulin and let them eat foods that
have high glycemic indexes. People would be better served, picking their
carbohydrates, if they looked at the glycemic index rather than trying
to mess around with calories.

RM: The glycemic index is something that I have favored
for years and I have Web pages about it. But it is not at all accepted
in the United States!

MB: Its a shame. And we hope we can change that.
One reason is that it is expensive to get accurate glycemic indexes on
foods. Its not cheap to do.

RM: It costs over $1,000 per test according to Jennie
Brand Miller.

MB: Right.

RM: And I know that Dr. Wolever in Canada, with whom
I have been in regular e-mail contact, tells me that he has been trying
to work something out where glycemic indexes would be shown on packaged
foods. Have you been in touch with him?

MB: I have not. I know Brand Miller. She is Australian?

RM: Thats correct.

MB: We went to great lengths to get her book. Actually,
Ill tell you a little aside. I am a medical consultant to Freeport-McMoRan.
Freeport has the largest copper and gold mine in Indonesia. That is another
problem right now as you can gather from the papers. But what I did is
that we have an office is Cairns, Australia. And our office got the book,
The G.I. Factor, and in fact we have referenced that book in our
book. I got in touch with Dr. Miller and got permission to use one of
her graphs and also to reference her.

Everything that weve done, all of the science,
all of the medical-related graphs and so forth I can tell you are 100
percent accurate. We went to the best sources and talked to them and got
permission and reread their data and looked at their references to make
sure that what we have in there is correct.

RM: Who is the glycemic index expert on your team,
which doctor?

MB: Louie Balart would be the best one.

RM: The reason why I ask, and I want to talk to him,
because there are about six different foods where there are differences.

MB: Some have different standards. The ones that we
have worked with used glucose as 100.

RM: I wrote Jennie Brand Miller telling her where
I thought there were some differences...

MB: There are some differences in the way they do
foods.

RM: I know how complicated this is.

MB: You take Cheerios that are available in Australia,
because we buy Cheerios out of Australia for our project in Indonesia.
They are white, they are not a whole-oat Cheerio. However, if you buy
Cheerios in the States it is a whole-oat Cheerio. So we kind of push Cheerios
a little bit, because even though it appears on her glycemic index to
be kind of high, its a different Cheerio.

RM: Excellent point. Im glad you made that.

MB: We are learning. We dont profess to know
hardly anywhere the answers to the questions we ought to know, over the
last couple of years we know more than we knew two years ago. I can tell
you this: as we have progressed with this, we are seeing now in the medical
literature, there is a nice article out of Canada, Després and
his group looking at the deleterious effects of high insulin levels in
the New England Journal of Medicine, April 1996 [Després,
J.P., et al, "Hyperinsulinemia as an independent risk factor for
ischemic heart disease," New England Journal of Medicine,
1996 Apr, 334:15, 952-7.] They concluded that high insulin levels is as
much of a risk factor for coronary artery disease, arteriosclerosis, as
is smoking, hypertension, diabetes, etc. Then in Circulation, January
1996, Dr. Gerald Berenson published a study done over about 20 years looking
at a population in a certain community in Louisiana, Bogalusa, the first
identifiable abnormality in young adults before the onset of obesity,
hypertension, diabetes, or symptomatic cardiovascular disease is a rising
insulin level [Bao, W., Srinivasan, S.R., Berenson, G.S., "Persistent
elevation of plasma insulin levels is associated with increased cardiovascular
risk in children and young adults. The

Bogalusa Heart Study, Circulation, 93(1):54-9
1996 Jan 1.] So, we know that it would be best to try to keep insulin
levels as well within the normal range as possible and probably one day
now that we can measure insulin levels cheaper the way that they are going
to manage a diabetic is not go in and say we want your blood sugar here
and throw whatever insulin is necessary to keep it there, they will try
to more eloquently manage patients, they are going to try to keep their
insulin levels within a certain range and then you are going to control
not only the blood sugar, but you are going to eliminate the deleterious
effects of high insulin.

RM: Excellent. Who actually wrote the book? Did you
divide up the chapters?

MB: All four of us divided up the chapters. I made
an outline. I assigned chapters. We all four wrote different chapters
and then Leighton Steward and I rewrote everything so it would look as
if it was written by one person and not four.

RM: No ghost writer?

MB: No ghost writer. You are looking at the writers.
In fact, Ill tell you a funny story. We finished that book, Leighton
and I finished writing it, and after we finished it I told my wife, "You
know, we are going to send it to the printer." This was the first
book, we self-published it. And she said, "Youve got to have
somebody proofread." "What do you mean, proofread?
Leighton Steward has a masters in geology, Ive got an MBS
and M.D. degree, we know all about this stuff." My wife said, "Just
the same we are going to get the chairman of the English department at
the school where my kids go to read it for grammar and punctuation."
When we got that back it looked like a Christmas tree. The lady didnt
change the text. She just said, "You need a hyphen here." In
one instance she said, "This isnt a sentence." So anyway,
thats all of the ghost assistance.

RM: Are you familiar with amazon.com?

MB: Yes, I am. I am becoming a little more computer-literate.
Saw Andrews, who is the endocrinologist in the group, knows more about
computers.

RM: Amazon.com has a "Health, Mind and Body"
bestseller list. And Sugar Busters! Right now is number 2 on that list.
It was recently number 1 on the Los Angeles Times "Healthy
Bestsellers" list. Are you surprised?

MB: No, Im not. And I will tell you why I am
not surprised. The first book we self-published.

RM: How many copies did you sell?

MB: 210,000 as of the middle of February. Thats
the frst book. The second book, they have printed and shipped about 300,000.
Now, do you know what our marketing budget was for the first book? Zero.
The first book we knew would do okay, because our concept is sound. If
anybody looked into the scientific validity of it, they would see that
it is sound. And secondly, it works. And any time you are promoting a
product that you have done simply and understandably and it works, its
going to be a success. Now, Im not trying to pat myself on the back,
but I will tell you a couple other things we did. If you notice, the print
in the book is big. There is pretty good spacing between the lines. When
Random House, Ballantine, decided to publish this book for us, they said,
"You know, the book stores are going to think that you are trying
to rip them off, because the book looks fatter than it is." We said,
"No, no, no. You missed the whole point. You dont know who
we are writing to. We are writing it for people like me, who now wear
glasses to read. When they get home from work at night we are already
tired. We dont want to squint to see anything. So I am not interested
whether somebody thinks the book is padded or big or thin, I have x amount
that I want to say and Ive said it. I want people to be able to
read it comfortably. So you leave the print (the type size) and the spacing
the same." They said, "Oh, excuse me. We didnt realize
that." And they did [leave it the way we presented it].

RM: Its a beautiful job. Its a good looking
book. You deserve every bit of your success and I hope that I can do my
bit to push it forward. Its helped me!

MB: Thank you, sir. And we have been very pleased
with the responses we have seen from diabetics. We do do this: we caution
anyone who is diabetic who goes on Sugar Busters! to consult with their
physician, because, yes your insulin levels may become less and the requirements
[may drop]. If you are taking insulin, you need to let the physician know,
so that it can be adjusted and followed. If you are on an oral hypoglycemic
agent, you may not need it any longer. We are not saying, go out and treat
yourself. This needs to be done in concert with your physician.

RM: Excellent point. You made so many wonderful points
for me....

MB: ...the reward and benefit that we have gotten
out of this in talking to people such as yourself who have tried it and
who have benefited from it, we hope will be healthy and happy as a result
of it.